Josephine Frimpong, right, an Advanced Practice Nurse (APN) at University Hospital in Newark cares for Sonia Maria De Assis in the new "observation unit, " created to relieve overcrowding and fix state inspection violations in the emergency room.
(Robert Sciarrino/The Star-Ledger)

NEWARK — Ordered by the state to reduce overcrowding in one of New Jersey’s busiest emergency rooms, University Hospital officials say they have relocated nearly half of the beds in a new observation unit to monitor less seriously ill patients.

For the last decade, the Newark hospital’s main emergency department, which treats nearly 100,000 patients a year, has had room to serve 42 people at a time — even though space permitted only 21 patient bays.

Suzanne Atkin, the hospital’s chief medical officer, said that lacking room to expand, the hospital — which is North Jersey’s only level one trauma center — doubled up by adding a stretcher to each bay and separating the patients with a curtain.

"We were doing our best for the citizens of Newark," Atkin said. "As hospitals in Newark closed over time, we ended up with more patients seeking care."

But after a patient complained last summer about the lack of privacy in the emergency room, state inspectors cited the hospital for violating square foot regulations and urged its administrators to find a better way to serve its patients.

The solution was to open an 18-bed observation unit on another floor that accepts emergency room patients who are neither in crisis nor ready to go home either.

By moving the less critically ill and injured patients out, Atkins said, the emergency room can focus on the people who need the most care, and that the unit can accommodate up to 30 patients if necessary.

In the first five days of the two-week-old unit, 40 patients were treated for conditions like dehydration, nausea, pain associated with sickle cell anemia, asthma and chest pains, Barbara Carroll, executive director of patient care services, said. They were treated and monitored in semi-private and private rooms with flat-screen TVs, Carroll said.

"Everyone who comes into the emergency department gets a full evaluation and they may get admitted or treated and released," Barbara Hurley, a hospital spokeswoman, said. "But rather than occupying a bed or a bay in the ED (emergency department), patients who are waiting for tests would be transferred to the observation unit, which is a less hectic and more relaxed environment."

Some employees said they were concerned whether there would be enough staff to cover the unit, and whether the main emergency room was big enough to meet the demand.

"As nurses, our main concern for any patient area in the hospital — whether the Emergency Room, ‘observation beds or medical floors — is safe staffing levels to provide safe care to our patients. We are working with University Hospital to make sure that both the ER and the observation beds are always well-staffed by nurses and other essential staff," said Elmer Daniels, a registered nurse and president of the local chapter of Health Professionals and Allied Employees, which represents 1,250 nurses and other medical professionals at the hospital.

"Patients coming from the ER have high ‘acuity’ levels, and need to be assured of adequate nurse staffing. With that in place, we are in support of University Hospital’s development of observation beds," Daniels said.

The main emergency department could expand from 21 to 27 bays if necessary, and there are contingency plans to temporarily add stretchers if demand requires it, Atkin said.

"We hope for that never to happen, but we will do whatever we can . . .I don’t anticipate it happening often," she said.

In addition to the main emergency room, there hospital’s emergency department maintains four other treatment areas for patients needing pediatric, psychiatric, trauma, and mild to moderate treatment, hospital official said.

Many hospitals across the country are using observation units to reduce emergency room wait times and avoid unnecessary hospital admissions — benefits that Atkin said University’s patients will now enjoy.

The publicly-funded hospital has undergone a lot of changes since July 2013, when the state spun it off as an independent entity after dissolving the University of Medicine and Dentistry of New Jersey.

In addition to the observation unit, the hospital has opened a health clinic in an effort to promote preventative care and cut down on emergency room use.

"We are known for excellent trauma care and emergency care and this won’t change that," Atkin said. "This will only makes us more efficient."